Leading the Way

Neurosurgeon Frank Culicchia in the O.R.

Local Doctors Talk Medicine

by Leslie Cardé

WITH THE EXCEPTION OF YOUR PARTNER, your parents, or your pastor, there is perhaps no closer bond than that of a doctor and a patient. Doctors are with us at the best of times, when a new life comes into the world, and at the worst of times, when we battle foes, like cancer. We entrust psychiatrists with our deepest inner thoughts, and plastic surgeons with their abilities to wield knives on that most precious of commodities, our faces. And, speaking of precious commodities, where would any pet-lover be without the wise counsel of their favorite veterinarians, who now engage in everything from brain surgery to behavioral therapy.

As such, the readers of Inside New Orleans magazine were not

hesitant to weigh in on the leading doctors in their lives. The survey considered 27 different medical sub-specialties. When the results were tallied, 150 doctors in the New Orleans metro area made the list. Some of those doctors who were chosen weighed in about the state of medicine in their specific fields, as well as what’s looming on the horizon.

Perhaps nothing was more in the line of fire during the past two years of a pandemic than our skin. Mask mandates have wreaked havoc with our faces, causing breakouts and irritation. And, dermatologists have seen their fair share of patient do-it-yourself treatments.

“In 2021 patients were throwing so many different products at their skin in what I call lockdown experimentation,” says Dr. Zeena Al-Dujaili of New Orleans Aesthetics. “This often accounted for overly sensitized and irritated faces. You see, people often buy the latest skin care products and treatments without really considering what their skin actually needs. I’m hoping that in 2022, more people will embrace the inside-outside approach to skin care, strengthening the skin from within.”

Al-Dujaili says this can be accomplished with radiofrequency microneedling treatments which penetrate deeper than the skin’s surface, improving texture, stimulating collagen and elastic tissue while reducing scarring and wrinkles. Combining this with superficial treatments for pigmentation, veins, and brightening, and you have the ultimate rejuvenation option for those who want to age gracefully.

I asked dermatologist Elizabeth Grieshaber of Terezakis and Grieshaber Dermatology about trends in her specialty, and she tells me every trend isn’t necessarily a good thing.

“When you’re talking about aesthetics, you want to enhance the features you already have,” explains Grieshaber, “rather than changing your face. I see lots of overdone cheeks, overdone lips, and overdone chins. Big cheeks, for example, on a face where it doesn’t belong, just looks unnatural.”

Grieshaber, conversely, is a proponent of the natural look, and says people who are going for that puffed-up look, without a line or crease in their face, are probably going elsewhere for treatment, as it’s just not her thing. But, she is seeing patients >>

Clockwise: Dr. Zeena Al-Dujaili; Facial Plastic Surgeon Parker Velargo; and Facial Plastic Surgeon Claire Melancon. earlier for neuromodulators like Botox, even as young as their twenties. “This may sound young, but if you start treating these lines earlier, you don’t etch them into your face,” Grieshaber notes. “There’s one coming on the market soon that will be longer lasting, which means spending less time in your doctor’s office.” For facial plastic surgeon Claire Melancon of Audubon Facial Plastic Surgery, she has seen the influence that social media has had on aesthetic interventions, and it’s a mixed bag. “In many ways, it’s educated the average patient, making them more knowledgeable about what’s out there,” comments Melancon. “On the other hand, social media has also contributed to unrealistic expectations at times, with impossible filters and highly editable photographs. It’s essential that patients see doctors with the skillset and training to provide good counsel, an aesthetic eye and safe practices.” For those interested in creating facial harmony without the “done” look, there are plenty of new techniques which lend themselves to subtlety but give the face a younger look. For instance, injectables to enhance your lips may not always be the best option.

“As you get older, you lose volume in your lips, particularly your upper lip,” explains facial plastic and reconstructive surgeon Parker Velargo of New Orleans Center for Aesthetics and Plastic Surgery. “We can now do what’s called a lip lift, where we make a small incision underneath the nose and actually raise the lip, exposing more of the red underside. It’s a great way to permanently get an augmented upper lip, without repeated fillers. And that shorter interval between your upper lip and the tip of your nose gives a more youthful appearance.”

If you live in New Orleans, with its great, but certainly rich food, gastric distress isn’t an uncommon issue. But, when Maalox and Pepcid aren’t doing the trick, gastroenterologists are there to rescue us. They treat everything from reflux esophagitis to the more serious conditions under the irritable bowel syndrome umbrella—like Crohn’s disease and ulcerative colitis.

“There have been so many new drugs to treat the GI issues which people suffer with,” remarks Vernon Carriere, gastroenterologist with Metropolitan Gastroenterology Associates. “Proton pump inhibitors like Protonix, Nexxium, or Prilosec now block all three

paths your body uses to produce acid, whereas the earlier photo: MELANIE LANGTEAU histamine blockers only addressed one. And, for the more serious GI ailments, we are now using biologics and even agents which suppress the immune system.” And, it is the gastroenterologist you should be seeing if you’ve not had a colonoscopy, and fall within the recent protocols for frequency. “Yes, the guidelines have changed recently,” notes Carriere. “We now recommend screening at 45. If everything looks normal, you’re good for 10 years, but if you’re positive for polyps, screening could be more frequent. We want you to come before you have symptoms, because colon cancer has much better outcomes when it’s caught early.” And, on the horizon, Carriere says there will be a blood or stool test which will get the whole population >>

METROPOLITAN GASTROENTEROLOGY ASSOCIATES photo:

MICHAEL PALUMBO photo:

Top: Gastroenterologist Vernon Carriere. Above: Hand Surgeon Eric George. Right: Infectious Disease Specialist Julio Figueroa. screened without colonoscopies. The hope is that these tests will find markers that will be even more accurate than what we have today.

If you’re an NFL player and you’ve injured your hand, there’s a good chance you’ve seen hand surgeon Eric George. Whether it’s Alvin Kamara or Cam Jordan, these players have counted on him to stabilize them and get them back on the field. But, he treats mere mortals, as well (even me, when I broke my wrist in three places a few years back), and sees everything from carpal tunnel problems to total reconstructions. And now, our lifestyles with ever-present computers have given rise to repetitive use syndromes.

“People are keyboarding all day at work, then keyboarding in their social lives, which can lead to a real increase in repetitive motion disorders, like basilar thumb surgery, for example,” recalls George. “Our thumbs were originally weight-bearing joints, back when we were quadrupeds running around on all fours. And now, as upright creatures, we have opposing thumbs, and people are much more prone to arthritis.”

The strides in hand surgery techniques for professional athletes and weekend warriors have been monumental. When Drew Brees tore his ligament, tape was used to stabilize the joint.

“And, we now use anchors to stabilize joints that we used to have to drill,” explains George. “These anchors are what mountain climbers use. That’s how Russell Wilson (Seattle Seahawks) was fixed, and that’s how I’ll do Taysom (Hill). With a locking plate, you can start early motion within 3-4 weeks.”

Innovation is the key to recovery, and with nerve transfers in which the surgeon takes a good nerve and does a jump graft to a bad nerve, thereby enervating it, injuries which used to cause paralysis are a thing of the past.

How could we discuss doctors in an era of Covid, without including those on the front lines—the infectious disease specialists? LSU Health’s Chief of infectious Disease, Julio Figueroa, who helps other hospitals develop protocols for Covid, notes that fully 1/3 of his current patient consults are related to the virus.

But, infectious disease doctors have taken care of serious infections long before the pandemic hit, and will be dealing with them long after. Treating patients with sepsis, open wounds and the more complicated bone and joint infections, LSU has now opened the MusculoSkeletal Infectious Disease Center at University Medical Center. Tools to diagnose and treat raging infections have expanded by leaps and bounds with more rapid tests and diagnostic measures that enable ID specialists to more quickly treat problems like pneumonia and septic shock.

“Culturing organisms has always been a lengthy process which could take 72 hours for results,” explains Figueroa. “Now, blood can be analyzed in a couple of hours, detecting nucleic acids which tell physicians precisely what organisms they’re dealing with, and

what resistance they might have to certain antibiotics. Within half a day, we’re targeting treatments.”

Ironically, as much as all of us have bemoaned the effects of a pandemic, it has expedited research and development in the arena of infectious disease, which will have positive effects for all of us down the road.

It was 1983 when I covered the first in vitro >>

Reproductive Endocrinologist Sissy Sartor.

fertilization (IVF) in the state, performed by Dr. Richard Dickey of The Fertility Institute of New Orleans. Decades later, his legacy lives on, as IVF has become commonplace in dealing with the problems of infertility. Meanwhile, a whole array of other modalities has been added to the line-up of newer diagnostic and treatment methods, all stemming from an initial consultation and evaluation.

“If you’re under 35 and you’ve been attempting to get pregnant for a year or more, or over 35 and it’s been more than 6 months, we initiate a work-up to find the reason,” explains Sissy Sartor, reproductive endocrinologist, and infertility specialist at The Fertility Institute of New Orleans. “Statistically, getting pregnant favors the young. By the time you reach 40, your chances of getting pregnant are cut in half from the peak time in your midtwenties.”

The problem in many cases can be older eggs, which may not have the appropriate number of chromosomes, and that can lead to embryos which are not viable. It can also lead to birth defects, although screening tests have come a long way.

“We used to only have amniocentesis and chorionic villi sampling in our arsenal, but there’s now a blood test which can be done at 10 weeks, where fetal DNA floating in the mother’s bloodstream can be tested for abnormalities,” recounts Sartor.

Problems with infertility are never just a female problem. Low sperm counts can account for problems getting pregnant, but new research shows that even miscarriages might be tied to male issues.

“Problems with infertility have traditionally been directed at women,” explains Sartor. “Now we know that sperm can play a part in recurrent miscarriages. After all, men are half of the genetic information. We’re now looking at their DNA, determining whether it might be fragmented.”

And, with women delaying pregnancies until their careers have taken off, the freezing of eggs has seen a radical uptick. Ten years ago, new rapid freezing techniques that involve concentrated cryoprotectants have made the freezing of eggs much more successful. Sartor says that over the last three years, fertility preservation has increased by 50% each year.

Perhaps nothing strikes fear in a patient more than a cancer diagnosis. And, depending upon what type of cancer it might be in what particular organ, the prognosis can sometimes be grim. But, according to medical oncologist Ashish Udhrain of the Thibodaux Regional Health System, the new science in this arena is advancing faster than one can imagine.

THIBODAUX REGIONAL HEALTH SYSTEM photo: Medical Oncologist Ashish Udhrain.

“Every three weeks there is a new cancer treatment drug coming into the marketplace,” Udhrain says. “And while medical oncology can be challenging, this is what makes it exciting, at the same time.”

Personalized medicine is the new plan of attack, according to Udhrain. It means focusing cancer care toward a specific mutation in the patient’s tumor, with the focus of cancer care over the last few years utilizing the patient’s own immune system to attack and kill cancer cells. Hopefully, says Udhrain, the future will hold vaccines for cancer.

Speaking of tumors, an estimated 700,000 people in the United States are living with a primary brain tumor, 30% of which are malignant. It’s a topic neurosurgeon Frank Culicchia of Culicchia Neurological is all too familiar with, as brain tumor removal is the primary surgical procedure he’s engaged in—not just malignancies, but benign (noncancerous) tumors, as well. >>

Obstetrician/ Gynecologist Elizabeth Lapeyre.

Ophthalmologist Barry Leader.

“If you don’t remove a benign tumor, the cells can mutate and become resistant to treatment, and eventually malignant,” explains Culicchia. “As to what causes brain tumors, there’s lots of speculation. Some believe it’s a stem cell issue, or a mutation, while others believe it may be tied to a deficient immune system. Immunotherapy revs up the immune system and has had some success eradicating tumors, and ongoing clinical trials have produced drugs like Timidor, an oral medication with far less side effects than infusion-based chemotherapies.”

Brain tumors can be vexing, however, especially when dealing with something as lethal as a glioblastoma, which can grow back a month after being excised... its epicenter and tentacles quite elusive. But, Culicchia says that living with that particular tumor for five years was previously thought to be impossible, but five years and beyond is now a reality.

Most neurological surgeons do primarily spinal surgeries and only a small percentage of brains, whereas Culicchia only does brain surgery. His colleagues often wonder why. “I think it must be a personality thing,” muses Culicchia. “I like a challenge. Many of my colleagues wonder why I’d want to do something so depressing, where everyone dies. But everyone doesn’t die, and I’m up for the challenge of trying to figure it out, fighting every day to keep people alive.” When it comes to the field of obstetrics and gynecology, Elizabeth Lapeyre, medical director of the Women’s Wellness and Survivorship Center at Ochsner Baptist, as well as the medical director of Integrative photo: NEW ORLEANS EYE SPECIALISTS Oncology for the Gayle Benson Cancer Center, believes in an integrative approach. By utilizing specialists as diverse as oncologists, urologists, and those in maternal fetal medicine, she brings a team together that provides women with the expertise and confidence to get through any situation, no matter how complicated. “Apart from the basic preventive measures like mammogram screenings which we now recommend at 40, we want women to see their doctors every year, not just for obstetrical and gynecological issues, but for assessments which will determine their risk factors for heart disease and other cancers,” recounts Lapeyre. “We are focused on overall wellness, including weight loss, nutrition, and stress, and we deal with cancer survivors and their side effects from treatment.”

Problems like pre-eclampsia, a pregnancy complication characterized by high blood pressure and possible signs of damage to other organ systems like the kidneys and liver, are being dealt with in a pro-active manner.

“Although baby aspirin is recommended, it’s still a problem we see a lot of,” notes Lapeyre. “Thanks to our monitoring program called Connective MOM (Maternity Online Monitoring), we can monitor people at home, and keep an eye on anything that might be brewing.”

With innovative programs in labor and delivery, which include fetal monitoring from a central location, in addition to monitoring on the floor, there’s an additional safety net. If anything looks untoward, there’s someone on it, immediately.

Perhaps in no other specialty than ophthalmology have so many advances come about so quickly, and in areas that affect so many different individuals.

Literally, just released, is the drug that is touting itself as the way to toss your reading glasses. Called Vuity, I got the lowdown on the new drug from Barry Leader, an ophthalmologist with New Orleans Eye Specialists.

“These are pilocarpine eye drops that I’ve used for years to treat glaucoma, but in a different strength,” explains Leader. “The drops make the pupil smaller, letting in less light and creating a pinhole effect which increases your depth of field and allows you to see things clearly, close up. It’s a once-a-day drop but comes with some caveats. It’s not good if you’re working in dim light and has some age restrictions, working best if you’re between the ages of 45 and 55. After the age of 60, it doesn’t really help, but it could forestall the use of reading glasses for a decade or more.”

If dry eyes are a problem, a new nasal spray called Tyrvaya could be just the relief you’re looking for. According to Leader, the spray stimulates tear production, unlike other drugs which dampen inflammation or lubricate the eye. So far, samples he’s >>

IMAGES BY ROBERT T. photo:

Plastic and Reconstructive Surgeon David Jansen.

Plastic and Reconstruction Surgeon Ravi Tandon. given out have elicited no side effects, other than a slight peppery sensation as it’s being sprayed up the nostril twice a day.

And, from a cosmetic standpoint, there’s a new treatment for droopy lids (ptosis), which occurs naturally as we age. To date, surgery has been the only intervention that raises the lid.

“Now, there’s a drug called Upneeq, which stimulates one of the upper eye muscles and lifts the lid,” recounts Leader. It’s a once-a-day drop and works similarly to raising a window shade.”

With advances in glaucoma and cataract surgeries and new treatments for age-related macular degeneration, patients are experiencing a clearer world.

When it comes to plastic and reconstructive surgery, the advances in body shaping are unparalleled. Just ask David Jansen of Jansen Plastic Surgery who has been on the cutting edge of new techniques in breast augmentation, arm lifts, liposuction and beyond, for decades.

“We are now combining body sculpting with liposuction with “shrink wrapping” in a combination technique which moves fat and shrinks skin,” says Jansen. “There are connections between the skin, the muscles and fat. If you shrink the connection between the skin and the fat with a heating element (high heat for a short period of time), you literally shrink the skin to the new dimensions created by removing fat.”

For Ravi Tandon, plastic and reconstructive surgeon at Tandon Plastic Surgery, most of his practice is devoted to reconstructive techniques for those who have mastectomies due to cancer, or have opted for prophylactic mastectomies after determining their >>

high risk for that disease.

“In regard to reconstructive breast surgery, there are trends toward a more natural appearance using hybrid techniques which can include using surplus abdominal fat to fill the breast cavity with one’s own tissue,” recounts Tandon. “We are now using the most advanced techniques with nerve grafts to recreate sensation in the breasts, so you not only look, but potentially feel more like yourself again.”

You may not know that congenital heart disease is the most common defect at birth, but it’s a fact that pediatric cardiothoracic surgeon Timothy Pettitt deals with routinely at Children’s Hospital of New Orleans. He not only does the initial surgeries on the infants who present with difficulties, but may later see these patients, now in their 30’s, 40’s and 50’s.

“These are patients who had surgery shortly after they were born, but as adults may run into problems that an adult cardiothoracic surgeon who routinely does bypasses, doesn’t want to deal with, because congenital issues are very specific,” recounts Pettitt. “When these kids grow up, they may have diabetes, emphysema, or some other problem, but we’re the only center in Louisiana to be accredited by the LA Heart Association. We have two surgeons who are board certified in congenital heart disease, so yes, we see adults.”

Many of these kids are born with one ventricle instead of two. It requires a series of operations to rearrange their plumbing to allow them to live with only one ventricle.

“In a normal situation, the right ventricle goes to the lungs, the left to the body,” explains Pettitt. “Now, with the surgery, instead of two parallel circulations, you have one ventricle that goes to both the lungs and the heart. So, they are now working in series rather than circulating in parallel.”

In the future, according to Pettitt, we may be able to clone hearts from a patient’s own tissue. “It may not be in my lifetime,” says Pettitt. “But, I think it’s coming.”

If you’re a pet owner, you know that your veterinarian provides a critical lifeline when it comes

CHILDREN’S HOSPITAL OF NEW ORLEANS photo:

to taking care of your fur babies, who cannot speak for themselves and tell you what’s bothering them. Our vets must divine from outward symptoms alone what’s ailing our furry friends.

“New Orleans, with its heat and humidity can cause problems for our animals,” explains veterinarian Meredith Addison with Metairie Small Animal Hospital. “Because of the heat, we see many patients in the summer presenting with heat stroke from either running or playing in the heat for too long, or being outside beyond what they can tolerate. On top of that, if you have a brachycephalic breed with a shortened snout, like a pug or bulldog, not able anatomically to tolerate heat, it can lead to dangerous if not fatal consequences.”

The climate, according to Addison, is a year-long breeding ground for both fleas and heartworms, as parasites flourish in humidity. And, allergies abound in this soggy climate. She sees three to five appointments a day for dermatologic conditions caused by allergies.

Dogs and cats who were acquired during the pandemic when their owners were at home, are now suffering the effects of being left alone, as their owners return to work.

“I’ve seen a number of appointments for behavioral problems,” recounts Addison. “The animals are experiencing separation anxiety because of being left home alone. And they aren’t being socialized as much with other animals either, due to the effects of the pandemic. We now have animal behavioralists who deal with these issues.”

Medications and medical diagnostics in the veterinary world now rival the human experience. Animals are now having root canals, heart surgery and even pituitary surgery, beneath the brain. For pet owners who often refer to their pets as their ‘children’, any innovations that keep their best friends around a little longer is certainly welcomed.

To see the full list of our readers’ favorite doctors, read the complete survey, which follows.

METAIRIE SMALL ANIMAL HOSPITAL photo: Veterinarian Meredith Addison.

Leslie can be reached at leslieinolamag@gmail.com.